Provider Demographics
NPI:1003661653
Name:PUPO, MARIA DE LOS ANGELES
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:PUPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4208
Mailing Address - Country:US
Mailing Address - Phone:561-601-4641
Mailing Address - Fax:
Practice Address - Street 1:1850 FOREST HILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6056
Practice Address - Country:US
Practice Address - Phone:561-284-0625
Practice Address - Fax:561-584-5033
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-336470106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician